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Booth AL, Voltaggio L, Waters R, Goldblum J, Feely MM, Agostini-Vulaj D, Pezhouh M, Gonzalez RS. Lobular capillary hemangioma (pyogenic granuloma) of the gastrointestinal tract: Clinicopathologic analysis of 34 cases. Am J Clin Pathol 2023; 160:411-416. [PMID: 37289424 DOI: 10.1093/ajcp/aqad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Lobular capillary hemangioma (LCH) rarely involves the gastrointestinal (GI) tract. This study describes clinicopathologic features of LCH in a cohort of GI cases. METHODS We defined lobular capillary hemangioma as "a proliferation of capillary-sized blood vessels arranged at least focally in a lobular configuration," searched departmental archives for cases, and recorded clinicopathologic findings. RESULTS We identified 34 GI tract LCHs from 16 men and 10 women; 4 patients had multiple lesions. Mean age was 64 years. Cases arose in the esophagus (n = 7), stomach (n = 3), small bowel (n = 7), and colorectum (n = 17). Twelve patients had anemia or rectal bleeding. No patients had a known genetic syndrome. The lesions manifested as mucosal polyps, with median size of 1.3 cm. Microscopically, 20 lesions were ulcerated, and most involved the mucosa, with 9 extending into the submucosa. Vessel dilation was present in 27 patients, endothelial hobnailing in 13, hemorrhage in 13, and focal reactive stromal atypia in 2. Follow-up information was available for 10 patients, none of whom developed same-site recurrence. Six of the 26 cases (23%) were extradepartmental consultations, including 2 of the multifocal cases. CONCLUSIONS Gastrointestinal tract LCHs often arise as colorectal polyps. They are typically small but can reach a few centimeters in size and can be multifocal.
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Affiliation(s)
- Adam L Booth
- Department of Pathology, Northwestern University, Chicago, IL, US
| | | | - Rebecca Waters
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, US
| | - John Goldblum
- Department of Pathology, Cleveland Clinic, Cleveland, OH, US
| | - Michael M Feely
- Department of Pathology, University of Florida, Gainesville, FL, US
| | - Diana Agostini-Vulaj
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, US
| | - Maryam Pezhouh
- Department of Pathology, University of California San Diego, San Diego, CA, US
| | - Raul S Gonzalez
- Department of Pathology, Emory University Hospital, Atlanta, GA, US
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2
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Tanaka T, Wada Y, Noguchi S, Nishida H, Akiyoshi H. Contrast-enhanced CT features of pyloric lesions in 17 dogs: Case series. Vet Radiol Ultrasound 2023; 64:262-270. [PMID: 36571176 DOI: 10.1111/vru.13193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 12/27/2022] Open
Abstract
Pyloric outflow obstructions can be caused by several types of lesions. When a thickened gastric wall and pyloric mass are detected, malignant neoplasia must be differentiated from chronic hypertrophic pyloric gastropathy. CT can characterize gastric tumors. However, based on the authors' review of the literature, there is limited information about the CT findings of pyloric lesions. The purpose of this retrospective case series study was to assess the CT findings of canine pyloric lesions. The following CT parameters were recorded: anatomical area, involved area, lesion shape, growth patterns of wall thickening lesions, enhancement pattern of the lesion in the early and delayed phases, lymphomegaly, and pulmonary metastasis. Seventeen dogs were included in this study and had the following final diagnoses: hyperplasia (five dogs), adenoma (five dogs), adenocarcinoma (three dogs), gastrointestinal stromal tumor (GIST; two dogs), polyposis (one dog), and pyogenic granuloma (one dog). Hyperplasia, adenoma, and polyposis formed mass lesions that involved the mucosal layer. Lymphomegaly was detected in two Jack Russell terriers with hyperplasia; however, the causes were unknown because we did not perform biopsies. All adenocarcinomas formed wall-thickened lesion that involved the outer layer, with lymphomegaly. All GISTs formed mass lesion that involved the outer layer. The pyogenic granulomas formed symmetric wall-thickened lesion that involved the mucosal and outer layers. CT facilitated the characterization of canine pyloric lesions using contrast enhancement, based on the involved area and lesion shape. However, polyposis may require caution in diagnosis based on CT findings alone.
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Affiliation(s)
- Toshiyuki Tanaka
- Laboratory of Veterinary Surgery, School of veterinary Science, Osaka Metropolitan University, Izumisano-shi, Osaka, Japan.,Kinki Animal Medical Training Institute & Veterinary Clinic, Higashiosaka, Osaka, Japan
| | - Yusuke Wada
- Veterinary Medical Center, School of veterinary Science, Osaka Metropolitan University, Izumisano-shi, Osaka, Japan
| | - Shunsuke Noguchi
- Laboratory of Veterinary Radiology, School of veterinary Science, Osaka Metropolitan University, Izumisano-shi, Osaka, Japan
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, School of veterinary Science, Osaka Metropolitan University, Izumisano-shi, Osaka, Japan
| | - Hideo Akiyoshi
- Laboratory of Veterinary Surgery, School of veterinary Science, Osaka Metropolitan University, Izumisano-shi, Osaka, Japan
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3
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Hayashi Y, Hosoe N, Takabayashi K, Kamiya KJL, Mutaguchi M, Miyanaga R, Hirata K, Fukuhara S, Mikami Y, Sujino T, Masugi Y, Naganuma M, Ogata H, Kanai T. Clinical and Endoscopic Characteristics of Pyogenic Granuloma in the Small Intestine: A Case Series with Literature Review. Intern Med 2020; 59:501-505. [PMID: 31611535 PMCID: PMC7056362 DOI: 10.2169/internalmedicine.3745-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic granuloma (PG) generally appears in the skin or oral cavity, but rarely occurs in the small intestine, where it can cause bleeding. To date, only 35 cases of small intestinal PG have been reported in the English literature. We retrospectively collected information from the clinical records of seven cases of small intestinal PG that were managed in our hospital and summarized the characteristics. Further information on the clinical characteristics was obtained from the literature. Capsule endoscopy, useful for identifying the source of hemorrhage in obscure gastrointestinal bleeding, can detect PGs. Treatment can often be accomplished with endoscopic mucosal resection.
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Affiliation(s)
- Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Kenji Jl Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Makoto Mutaguchi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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4
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Endoscopic Mucosal Resection of a Proximal Esophageal Pyogenic Granuloma. Case Rep Gastrointest Med 2019; 2019:9869274. [PMID: 31662914 PMCID: PMC6791219 DOI: 10.1155/2019/9869274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/10/2019] [Indexed: 11/23/2022] Open
Abstract
Pyogenic Granuloma (PG), also known as lobular capillary hemangioma, is usually seen as a polypoid red lesion found on the skin or the mucosal surface of the oral cavity. PG of the gastrointestinal tract is rare, in particular involving the esophagus, only 14 cases have been reported in the English literature. We present an 80-year-old male who underwent endoscopy for evaluation of dysphagia and was found to have a single, red, bilobed 10 mm polyp with adherent white exudate approximately 19 cm from the incisors. Endoscopic ultrasound was performed with a 20 mHz miniprobe which showed the lesion contained to the mucosal layer with no muscularis propria invasion. A decision was made to perform endoscopic mucosal resection (EMR). A mixture of saline and methylene blue was injected into the submucosal plane to raise the lesion with subsequent successful mucosal hot snare resection. The resection defect was then approximated and closed with a hemostatic clip to prevent bleeding. Pathology of the specimen revealed small capillary vessels growing in a lobular architecture with an edematous stroma and a florid inflammatory infiltrate representing a pyogenic granuloma. EMR allows for an en bloc resection of mucosal lesions with tumor-free margins, thereby providing both diagnostic and prognostic information. Comparing EMR with the novel technique of endoscopic submucosal dissection (ESD), the incidence of bleeding and perforation is much lower; making EMR the best and safest resection option for this rare hemangioma. In this case, we demonstrate that EMR is a safe technique in removing a pyogenic granuloma in the esophagus.
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5
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Zhang D, Glover SC, Liu W, Liu X, Lai J. Small Bowel Pyogenic Granuloma With Cytomegalovirus Infection in a Patient With Crohn's Disease (Report of a Case and Review of the Literature). In Vivo 2019; 33:251-254. [PMID: 30587632 DOI: 10.21873/invivo.11468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Abstract
Pyogenic granuloma (PG) represents a lobular capillary proliferation commonly seen in the skin or oral mucosa. They are rarely reported in the gastrointestinal tract. The mechanism underlying PG pathogenesis is not well understood. Only one case of cutaneous PG associated with cytomegalovirus (CMV) infection has been reported in the English literature. Here, we report such a unique case of PG arising from the small bowel. A 67-year-old male, status post ileocolic resection, presented for follow-up colonoscopy because of Crohn's disease of the terminal ileum and the colon. Colonoscopy revealed inflammation at the ileocolic anastomosis as well as an 8-mm pedunculated lesion with an irregular surface in the neo-terminal ileum. Histological studies of the small bowel mucosa revealed chronic active ileitis with pyloric gland metaplasia, consistent with his clinical history of Crohn's disease. The lesion demonstrated a lobular architecture consisting of clusters of small capillaries of various sizes lined by a single layer of cytologically bland endothelial cells, and accompanied by acute and chronic inflammatory infiltrates and surface erosion/ulceration. The histological features supported the diagnosis of PG. Scattered viral inclusions with positive CMV immunoreactivity were present in the endothelial cells and glandular cells of pyloric gland metaplasia within the PG. To the best of our knowledge, this is the first documented case of PG with local CMV infection in patients with inflammatory bowel disease.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Sarah C Glover
- Division of Gastroenterology, Hematology and Nutrition, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Weidong Liu
- Department of Surgery, Xiangya Hospital, XiangYa School of Medicine, Central South University, Changsha, P.R. China
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory of Medicine, University of Florida College of Medicine, Gainesville, FL, U.S.A.
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Suarez-Zamora DA, Rodriguez-Urrego PA, Solano-Mariño J, Sierra-Arango F, Palau-Lazaro MA. Esophageal Pyogenic Granuloma: A Case Report and Review of the Literature. Int J Surg Pathol 2018; 26:735-738. [PMID: 29737225 DOI: 10.1177/1066896918773476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pyogenic granuloma (PG) is a capillary hemangioma mainly found in the skin and oral mucosa, but rarely described in the esophagus. We report the case of a 66-year-old man who consulted for retrosternal pain. Endoscopic studies showed a 28-mm polypoid mass located at the distal esophageal mucosa. The patient underwent endoscopic resection, and the histopathological examination showed a neoplastic proliferation of small blood vessels growing in a lobular architecture, with edematous stroma and prominent inflammatory infiltrate. Special stains for fungus showed pseudohyphae compatible with Candida spp. Findings were consistent with those of an esophageal PG associated with Candida infection. This case is a reminder that PG can be found in the esophagus, can be associated with other entities such as Candida infection, and is one of the differential diagnoses of neoplastic vascular proliferations that may mimic malignancy. In addition, we reviewed previously reported cases of esophageal PG.
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Affiliation(s)
- David A Suarez-Zamora
- 1 Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
| | | | - Jaime Solano-Mariño
- 2 Division of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,3 School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Fernando Sierra-Arango
- 2 Division of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,3 School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Mauricio A Palau-Lazaro
- 1 Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,3 School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
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7
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Pham Hoang VL, Pham Dinh N, Nguyen H, Kitzmiller JP, Doan Hai LB, Nguyen H. Infraglottic lobular capillary hemangioma: A case report. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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8
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De María J, Curvale C, Guidi M, Hwang H, Matanó R. Pyogenic granuloma of the jejunum; diagnosis and treatment with double-balloon enteroscopy: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Qiu X, Dong Z, Zhang J, Yu J. Lobular capillary hemangioma of the tracheobronchial tree: A case report and literature review. Medicine (Baltimore) 2016; 95:e5499. [PMID: 27902613 PMCID: PMC5134768 DOI: 10.1097/md.0000000000005499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Lobular capillary hemangioma (LCH) of the tracheobronchial tree is a rare benign tumor, whose characteristics and treatments remain relatively unknown. PATIENT CONCERNS A 39-year-old man with hemoptysis caused by neoplasm in the bronchus intermedius was admitted to our hospital. DIAGNOSES The patient was diagnosed with LCH. INTERVENTIONS The lesions were removed with biopsy forceps, and cryotherapy was performed. OUTCOMES After follow up for more than 2 years, no recurrence was found. LESSONS Airway LCH can be treated by excisional biopsy, cryotherapy, APC, laser, radiotherapy, and surgery. Cryotherapy is worthy of recommendation.
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Affiliation(s)
- Xiaojian Qiu
- Department of Pulmonary Diseases, Beijing Tian Tan Hospital, Capital Medical University, Beijing
| | - Zhiwu Dong
- Department of Clinical Chemistry, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai
| | - Jie Zhang
- Department of Pulmonary Diseases, Beijing Tian Tan Hospital, Capital Medical University, Beijing
| | - Jin Yu
- Department of Pathology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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10
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Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia. Case Rep Gastrointest Med 2016; 2016:4398401. [PMID: 27403353 PMCID: PMC4925958 DOI: 10.1155/2016/4398401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 11/17/2022] Open
Abstract
Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.
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11
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De María J, Curvale C, Guidi M, Hwang H, Matanó R. Pyogenic granuloma of the jejunum; diagnosis and treatment with double-balloon enteroscopy: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 82:94-96. [PMID: 27161794 DOI: 10.1016/j.rgmx.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/11/2015] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J De María
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - C Curvale
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina.
| | - M Guidi
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - H Hwang
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - R Matanó
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
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12
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Wang B, Song B, Oster C, Cao J, Raza A, Wang J. Coexistence of intestinal Kaposi sarcoma and plasmablastic lymphoma in an HIV/AIDS patient: case report and review of the literature. J Gastrointest Oncol 2016; 7:S88-95. [PMID: 27034819 PMCID: PMC4783623 DOI: 10.3978/j.issn.2078-6891.2015.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 12/19/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection or acquired immunodeficiency disease (AIDS) is associated with increased risk for various malignancies including Kaposi sarcoma (KS) and lymphoma. We report a rare case of coexistence of KS and plasmablastic lymphoma (PBL) in the gastrointestinal (GI) tract in a HIV/AIDS patient. A brief review of literature is also presented.
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Affiliation(s)
- Bing Wang
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Bingbing Song
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Cyrus Oster
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Jeffery Cao
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Anwar Raza
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Jun Wang
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
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13
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Misawa SI, Sakamoto H, Kurogochi A, Kirii Y, Nakamura S, Misawa T, Yoneda S, Hirano M, Owa O, Takagi H, Ota H. Rare cause of severe anemia due to pyogenic granuloma in the jejunum. BMC Gastroenterol 2015; 15:126. [PMID: 26444414 PMCID: PMC4596517 DOI: 10.1186/s12876-015-0355-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pyogenic granuloma (PG) is a polypoid lobular capillary hemangioma rarely observed in the gastrointestinal tract. Only a few cases in the small bowel have been described in the literature. CASE PRESENTATION A 58-year-old man had been suffering from general fatigue and severe anemia. Esophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding. Abdominal computer tomography revealed a hypervascular tumor in the small intestine. Oral double-balloon endoscopy (DBE) detected a polypoid lesion (2 cm in diameter) in the jejunum. We performed laparoscopic-assisted partial resection of the jejunum. The histological features of the tumor were consistent with PG. The patient's anemia gradually improved without the need for oral iron after surgery. CONCLUSION In this case report, we present a case of pyogenic granuloma in in the jejunum that was detected by DBE.
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Affiliation(s)
- Shun-Ichi Misawa
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroto Sakamoto
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Akira Kurogochi
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Yasushi Kirii
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Shinichiro Nakamura
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Tomoko Misawa
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Suguru Yoneda
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Mari Hirano
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Osamu Owa
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroyuki Takagi
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroyoshi Ota
- Department of Biomedical Laboratory Sciences, Shinshu University, School of Medicine, 3-1-1 Asahi, Matsumoto, 3908621, Nagano, Japan.
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Abstract
A 53-year-old man with metastatic melanoma, in remission, presented with an 8-week history of melena and anemia. Initial investigations including upper and lower gastrointestinal endoscopy, capsule endoscopy, and Tc-labeled red blood cell scan did not reveal a source of bleeding. Given the concern over melanoma recurrence, F-FDG PET/CT was performed that demonstrated a focus of intense uptake in the small bowel. Uncomplicated surgical resection of the segment of jejunum containing the lesion was performed, after which the patient reported no further gastrointestinal bleeding. Histopathological assessment of the lesion was consistent with pyogenic granuloma.
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15
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Obscure gastrointestinal bleeding: resection of a pyogenic granuloma of the ileum via double-balloon enteroscopy. Clin J Gastroenterol 2015; 7:397-401. [PMID: 26184018 DOI: 10.1007/s12328-014-0524-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
Pyogenic granulomas usually occur on the skin or oral mucosa; however, they rarely develop in the gastrointestinal tract, particularly in the ileum. We report the case of an 82-year-old female who experienced occasional bloody stools. Initially, no significant bleeding source could be identified via conventional endoscopy; however, repeat capsule endoscopy identified a bleeding polyp (8 mm) in the ileum. Therefore, we resected the polyp via double-balloon enteroscopy. Histopathological findings showed increased, lobulated, and enlarged capillaries and desquamated epithelium indicative of epithelial erosion. In addition, neutrophil-predominant inflammatory cell infiltrate and interstitial edema were observed in the intercapillary stroma. Immunohistochemical analysis showed positive staining for vascular endothelial cell markers. Previous reports have mentioned that pyogenic granulomas in the oral cavity were associated with the female hormonal receptor, vascular endothelial growth factor, and proliferative immune markers; however, no significant staining was observed in our patient. This is the first report discussing an association between pyogenic granulomas and these markers. Pyogenic granulomas in the ileum are rare and may cause fatal anemia. Pyogenic granulomas should be considered in the differential diagnosis of obscure gastrointestinal bleeding.
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16
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Iwamuro M, Okada H, Tanaka T, Hori K, Kita M, Kawano S, Kawahara Y, Yamamoto K. Morphological Changes in a Pyogenic Granuloma of the Esophagus Observed over Three Years. Intern Med 2015; 54:1737-40. [PMID: 26179527 DOI: 10.2169/internalmedicine.54.4265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old Japanese man underwent routine esophagogastroduodenoscopy, during which a reddish, flat elevated lesion was observed in the middle third of the esophagus. A bright red area of protrusion appeared in the center of the elevated lesion three months later, and the protruded nodule grew to be a blood blister six months after the initial endoscopy examination. The morphology of the lesion changed from a protruded nodule to a mass with two humps that subsequently returned to a single hump during the three-year observation period. A histological diagnosis of pyogenic granuloma was made based on a biopsy performed at six months. This report illustrates a rare case of an esophageal pyogenic granuloma presenting with a unique endoscopic appearance and morphologic changes. Endoscopic ultrasonography images are also presented.
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Affiliation(s)
- Masaya Iwamuro
- Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Brandel DW, Al-Hawary MM, Wasnik AP. Retroperitoneal lobular capillary hemangioma with synchronous ipsilateral renal cell carcinoma. ABDOMINAL IMAGING 2014; 39:1137-40. [PMID: 25237004 DOI: 10.1007/s00261-014-0142-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lobular capillary hemangiomas (LCH) are acquired benign vascular tumors of skin and mucosal spaces of head and neck. Very few cases of LCH have been reported in the abdomen, predominantly occurring as mucosal polyps in the bowel. We present CT imaging features of solitary retroperitoneal LCH in a patient with synchronous ipsilateral renal cell carcinoma and review the available literature and imaging features in abdominal and extra-abdominal LCH. To our knowledge, there is no other case of retroperitoneal LCH available in the English literature.
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Affiliation(s)
- David W Brandel
- Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Egea Valenzuela J, Alajarín Cervera M, Hernández Agüera Q, Albaladejo Meroño A, Alberca de las Parras F. [Gastrointestinal bleeding due to a small bowel pyogenic granuloma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:384-5. [PMID: 24447889 DOI: 10.1016/j.gastrohep.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 10/31/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Juan Egea Valenzuela
- Unidad de Gestión Clínica de Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Miriam Alajarín Cervera
- Unidad de Gestión Clínica de Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Quiteria Hernández Agüera
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Aquilino Albaladejo Meroño
- Unidad de Gestión Clínica de Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Castle SL, Naik-Mathuria BJ, Kawaguchi AL, Shaul DB. Management of rectal pyogenic granuloma with transanal mucosal sleeve resection. J Pediatr Surg 2012; 47:1754-6. [PMID: 22974618 DOI: 10.1016/j.jpedsurg.2012.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/14/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022]
Abstract
In children, pyogenic granulomas are most commonly cutaneous benign vascular lesions but can also present in the gastrointestinal tract. When they occur in the intestine, they can cause acute or chronic gastrointestinal bleeding. We present an unusual case of rectal pyogenic granuloma and our management strategy.
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Erarslan E, Ekiz F, Unverdi H, Yılmaz B, Yüksel İ, Çoban Ş, Yüksel O. Unusual cause of acute gastrointestinal bleeding: gastric pyogenic granuloma. Dig Endosc 2012; 24:122. [PMID: 22348839 DOI: 10.1111/j.1443-1661.2011.01168.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Taccogna S, Crescenzi A, Stasi R, Turrini L, Gallo A, Rossi Z. Kaposi sarcoma of the stomach: a case report. BMJ Case Rep 2009; 2009:bcr03.2009.1666. [PMID: 21754959 DOI: 10.1136/bcr.03.2009.1666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 60-year-old man presented with persistent dysphagia and weight loss of 2-months duration. An upper GI endoscopy revealed mycotic oesophagitis and chronic gastritis with two ulcers of the gastric body and antrum. Repeat endoscopy was performed after medical treatment failed, and histological examination on new biopsy samples led to a diagnosis of Kaposi sarcoma of the stomach. HIV infection was not known at this time; however, the patient was tested after the diagnosis of Kaposi sarcoma was made and found to be HIV positive. An adequate biopsy sampling was required for histological diagnosis and the use of immunohistochemical markers, especially human herpesvirus 8 (HHV8) antibodies, supplied valid diagnostic support. This case underlines the importance of an accurate evaluation of vascular proliferation in gastrointestinal biopsies even in patients without clinical evidence of HIV-related pathology.
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Affiliation(s)
- Silvia Taccogna
- Regina Apostolorum Hospital, Surgical Pathology, via S. Francesco 50, Rome, 00041, Italy
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Pyogenic granuloma: an unusual cause of massive gastrointestinal bleeding from the small bowel. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:261-4. [PMID: 19373418 DOI: 10.1155/2009/579163] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.
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Park SY, Park CH, Lee WS, Kim HS, Choi SK, Rew JS. Pyogenic granuloma of the duodenum treated successfully by endoscopic mucosal resection. Gut Liver 2009; 3:48-51. [PMID: 20479901 DOI: 10.5009/gnl.2009.3.1.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 09/05/2008] [Indexed: 11/04/2022] Open
Abstract
Pyogenic granuloma is a lobular capillary hemangioma that occurs mostly on the skin and the mucosal surfaces of the oral cavity and tongue. Only a few cases in other parts of the digestive tract have been reported. Gastrointestinal pyogenic granuloma is a rare cause of hemorrhage in the digestive tract, but should be considered in the differential diagnosis of patients with gastrointestinal bleeding. We report the case of a 62-year-old anemic woman found to have a pyogenic granuloma of the duodenum, which was treated adequately by endoscopic mucosal resection.
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Affiliation(s)
- Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Ho-Yen C, Chang F, van der Walt J, Lucas S. Gastrointestinal malignancies in HIV-infected or immunosuppressed patients: pathologic features and review of the literature. Adv Anat Pathol 2007; 14:431-43. [PMID: 18049132 DOI: 10.1097/pap.0b013e31815946d9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The gastrointestinal (GI) tract is a common internal organ to be involved by human immunodeficiency virus (HIV)-related malignancies. It is the second most common site for Kaposi sarcoma after skin, and the commonest visceral site, for Kaposi sarcoma in AIDS patients. GI lymphomas have been documented in approximately 25% of AIDS patients with systemic lymphomas. Moreover, GI involvement of AIDS-lymphoma has been associated with poor prognosis and short survival. Several other malignancies that occur in the GI tract are also closely related to HIV-infected or immunosuppressed individuals; these include posttransplant lymphoproliferative disorder, Epstein-Barr virus-associated smooth muscle tumors, anal precancerous lesions, and squamous cell carcinoma. As a result of active antiretroviral therapy, patients infected with HIV are living longer and are consequently at increased risk for development of cancer. Therefore, it is possible that the number of AIDS-associated malignancies will rise and the pattern of tumors may change in the future. In this paper, the clinicopathologic features of GI malignancies associated with AIDS patients are reviewed and the differential diagnosis with other mimic lesions is discussed.
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Tanaka A, Kamada T, Hirakawa K, Koga H, Fujimura Y, Iida M, Tsunoda T, Sadahira Y, Haruma K. PYOGENIC GRANULOMA IN THE ILEUM. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.2007.00747.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Hoekstra ER, Fockens P, Scholten P. A 15-year-old boy with an esophageal pyogenic granuloma and subsequent Barrett's esophagus (with videos). Gastrointest Endosc 2007; 65:1086-8. [PMID: 17451698 DOI: 10.1016/j.gie.2006.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 10/20/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Elisabeth R Hoekstra
- Department of Gastroenterology, Sint Lucas Andreas Hospital, and Academic Medical Center, Amsterdam, the Netherlands
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